Sudden Severe Epigastric Pain in Surgery — 46yo Man | General Surgery | SMLE Q#799

SMLE Question #799

Surgery General Surgery
Last updated: February 2026
A 46-year-old man presents to the emergency department with sudden severe epigastric pain for 6 hours. He has taken high-dose ibuprofen daily for 3 months without gastroprotection. On examination, he has upper abdominal tenderness with guarding. An erect chest X-ray shows free air under the right hemidiaphragm. What is the most appropriate next step in management?

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